서 치과진료실에서는환자간의교차감염과환자와의료인력간의교차감염을방지하기위해고도의감염조절이요구된다 년 Caughman 등은복합레진을광중합시키는과정에서광중합기의손잡이와광섬유말단부가오염된다고하였으며, 특히광섬유말단은환자의구강점막과직접적인접촉을하기때문에교차감염의가능성이

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Download "서 치과진료실에서는환자간의교차감염과환자와의료인력간의교차감염을방지하기위해고도의감염조절이요구된다 년 Caughman 등은복합레진을광중합시키는과정에서광중합기의손잡이와광섬유말단부가오염된다고하였으며, 특히광섬유말단은환자의구강점막과직접적인접촉을하기때문에교차감염의가능성이"

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1 DOI: /JKACD 감염조절용차단막의두께가광중합기의중합광에미치는영향 장훈상 * 이석련 홍성옥 류현욱 송창규 민경산원광대학교치과대학치과보존학교실및치의학연구소 ABSTRACT Effect of infection control barrier thickness on light curing units Hoon-Sang Chang*, Seok-Ryun Lee, Sung-Ok Hong, Hyun-Wook Ryu, Chang-Kyu Song, Kyung-San Min Department of Conservative Dentistry, Wonkwang University College of Dentistry and Dental Research Institute, Iksan, Korea Objectives: This study investigated the effect of infection control barrier thickness on power density, wavelength, and light diffusion of light curing units. Materials and Methods: Infection control barrier (Cleanwrap) in one-fold, two-fold, four-fold, and eightfold, and a halogen light curing unit (Optilux 360) and a light emitting diode (LED) light curing unit (Elipar FreeLight 2) were used in this study. Power density of light curing units with infection control barriers covering the fiberoptic bundle was measured with a hand held dental radiometer (Cure Rite). Wavelength of light curing units fixed on a custom made optical breadboard was measured with a portable spectroradiometer (CS-1000). Light diffusion of light curing units was photographed with DSLR (Nikon D70s) as above. Results: Power density decreased significantly as the layer thickness of the infection control barrier increased, except the one-fold and two-fold in halogen light curing unit. Especially, when the barrier was four-fold and more in the halogen light curing unit, the decrease of power density was more prominent. The wavelength of light curing units was not affected by the barriers and almost no change was detected in the peak wavelength. Light diffusion of LED light curing unit was not affected by barriers, however, halogen light curing unit showed decrease in light diffusion angle when the barrier was four-fold and statistically different decrease when the barrier was eight-fold (p < 0.05). Conclusions: It could be assumed that the infection control barriers should be used as two-fold rather than one-fold to prevent tearing of the barriers and subsequent cross contamination between the patients. [J Kor Acad Cons Dent 2010;35(5): ] Key words: Infection control barrier; Light diffusion; Peak wavelength; Power density; Radiometer; Spectroradiometer -Received 29 July 2010; revised 12 August 2010; accepted 26 August Chang HS, DDS, PhD, Assistant Professor; Lee SR, DDS, Graduate Student; Hong SO, DDS, MS, Assistant Professor; Ryu HW, DDS, MS, Assistant Professor; Song CK, DDS, MS, Clinical Professor; Min KS, DDS, PhD, Associate Professor, Department of Conservative Dentistry, Wonkwang University College of Dentistry and Dental Research Institute, Iksan, Korea *Correspondence to Hoon-Sang Chang, DDS, PhD. Assistant Professor, Department of Conservative Dentistry, Wonkwang University College of Dentistry and Dental Research Institute, Shinyong-dong, Iksan, Korea Tel, ; Fax, ; , husch03@wonkwang.ac.kr * 이논문은 2010 년도원광대학교의교비지원에의해서수행됨. 368 Chang HS et al. JKACD Volume 35, Number 5, 2010

2 서 치과진료실에서는환자간의교차감염과환자와의료인력간의교차감염을방지하기위해고도의감염조절이요구된다 년 Caughman 등은복합레진을광중합시키는과정에서광중합기의손잡이와광섬유말단부가오염된다고하였으며, 특히광섬유말단은환자의구강점막과직접적인접촉을하기때문에교차감염의가능성이큰부위하고하였다. 1 Centers for Disease Control and Prevention (CDC) 의 Guidelines for infection control in dental healthcare settings-2003 에서는치과에서사용되는기구, 장치, 장비등을감염의잠재적위험도에따라 critical, semicritical, noncritical instruments 로분류하였다. 광중합기의광섬유말단은환자의구강점막과직접접촉하는 semicritical category 로분류되어가압증기멸균을하거나최소한 US Environmental Protection Agency (EPA) 에서인증하는멸균 / 소독제로고도의소독처리를해야한다. 그러나가압증기멸균이나화학용액으로멸균을할경우광섬유말단의유리섬유를파괴시키는경향이있어 2-4 투명랩과같은일회용차단막으로광섬유말단을감싸서사용하는것이보편적이다. 5-7 그러나감염조절용차단막은두께가매우얇아사용중찢어지는일이발생하기도한다. 따라서차단막을여러겹으로사용하여환자간교차감염의가능성을감소시킬수있을것으로보이나여러두께의차단막이광중합기의중합광에영향을미칠수있을것으로사료되어본연구에서는광중합기의광섬유말단을여러겹의차단막으로감쌀경우광중합기의광강도와파장, light diffusion 에미치는영향에대해조사하였다. 론 연구재료및방법 여러겹의감염조절용차단막이광중합기의광강도에미치는영향을알아보기위해감염조절용차단막으로투명랩 (Cleanwrap, Gimhae, Korea) 을 1 겹, 2 겹, 4 겹, 8 겹으로사용하였고할로겐광중합기 (Optilux 360, Demetron, Danbury, USA) 와 LED 광중합기 (Elipar FreeLight 2, 3M ESPE, St Paul, USA) 를사용하였다. 차단막으로광중합기의광섬유말단을감싸고휴대용광강도측정기 (Cure Rite, Kerr, Milford, USA) 의조사광측정부위에광섬유말단이접하도록하여제조사의지시에따라광조사개시 10 초후에광강도를각실험군마다 7 회씩측정하였다. 감염조절용차단막이중합광의파장에미치는영향을알아보기위해휴대용 spectroradiometer (CS-1000, Konica Minolta, Osaka, Japan) 를이용하여파장을측정하였다. 광중합기를고정시키기위해 cm 크기의 optical breadboard (Namil Optical Components Corp., Incheon, Korea) 에상하로 360 도회전이가능한 rotation stage 와 small multi axis translator 를설치하여 LED 광중합기또는할로겐광중합기의손잡이를고정시키고광섬유말단끝의조사면이 spectroradiometer 의렌즈와평행이되도록조절하였다. 휴대용 spectroradiometer 를이동시켜렌즈속초점의크기를광섬유말단의조사면크기에맞춘후광섬유말단에차단막을씌우고광중합기의파장을각실험군당 1 회측정하고데이터를 Microsoft Office Excel 2007 (Microsoft, Seattle, USA) 에서그래프로변환하였다. 감염조절용차단막이중합광의 light diffusion 에미치는영향을알아보기위해위에서설명한바와같이 breadboard 에광중합기의광섬유말단을위로향하게고정시킨후일안반사식디지털카메라 (D70s, Nikon, Tokyo, Japan) 를삼각대로고정시키고카메라렌즈 (AF-S Nikkor mm 1 : G ED, Nikon, Tokyo, Japan) 상에서광섬유말단의조사면이일직선으로보이도록조절한후, 광섬유말단에차단막을씌우고각실험군당 7 회씩사진촬영 (F3,5; 1/160 second) 을하였다. 촬영한사진은 Photoshop CS (Adobe systems, Mountain View, USA) 에서조사광가장자리의접선을연장한두선사이의각도를측정하여광섬유말단에서의 light diffusion 각도를얻었다. 여러겹의차단막을투과한광중합기의광강도와 light diffusion 에대한분석은통계분석프로그램인 SPSS 12.0K (SPSS Inc., Chicago, USA) 에서유의수준 95% 로 one-way ANOVA 를이용하였으며 Tukey HSD test 로사후검정하였다. 결 감염조절용차단막을투과한광중합기의광강도는 Table 1 과같다. Elipar Freelight 2 LED 광중합기의광강도는휴대용광강도측정기에서 1005 mw/cm 2, 차단막 1 겹을투과한광강도는 979 mw/cm 2, 2 겹은 969 mw/cm 2, 4 겹은 948 mw/cm 2, 8 겹은 925 mw/cm 2 로측정되었고이는대조군대비 1 겹에서는 97%, 2 겹은 96%, 4 겹은 94%, 8 겹은 92% 수준이었다. Optilux 360 할로겐광중합기의광강도는 519 mw/cm 2 로측정되었으며, 차단막 1 겹을투과한광강도는 497 mw/cm 2, 2 겹은 493 mw/cm 2, 4 겹은 475 mw/cm 2, 8 겹은 457 mw/cm 2 로측정되었고이는대조군대비 1 겹에서는 96%, 2 겹은 95%, 4 겹은 92%, 8 겹은 88% 로감소하였다. 두종류의광중합기모두에서감염 과 JKACD Volume 35, Number 5, 2010 Effect of barriers on light curing units 369

3 Intensity control 1-fold 2-fold 4-fold 8-fold Intensity control 1-fold 2-fold 4-fold 8-fold Wavelength (nm) Wavelength (nm) Figure 1. Wavelength (nm) of LED light curing unit with infection control barriers covering the filberoptic bundle. Figure 2. Wavelength (nm) of halogen light curing unit with infection control barriers covering the filberoptic bundle. Table 1. Power density (mw/cm 2 ± SD) of light curing units with infection control barriers covering the fiberoptic bundle Control 1-fold 2-fold 4-fold 8-fold FL ± 4 a 979 ± 3 b 969 ± 4 c 948 ± 4 d 925 ± 2 e O ± 5 f 497 ± 5 g 493 ± 3 g 475 ± 4 h 457 ± 4 i * The superscripts with the same letters are not significantly different at α= FL 2: Elipar FreeLight 2, O 360: Optilux 360. Table 2. Light diffusion (degree ± SD) of light curing units with infection control barriers covering the fiberoptic bundle Control 1-fold 2-fold 4-fold 8-fold FL ± 0.8 a 75.0 ± 2.4 a 74.4 ± 4.7 a 74.6 ± 0.9 a 72.0 ± 1.6 a O ± 3.1 b 47.4 ± 3.2 b 47.4 ± 2.3 b 45.1 ± 3.2 b 36.6 ± 3.4 c * The superscripts with the same letters are not significantly different at α= FL 2: Elipar FreeLight 2, O 360: Optilux 360. 조절용차단막의두께가증가할수록광중합기의광강도가유의하게감소하였다 (p < 0.05). 감염조절용차단막을투과한 Elipar FreeLight 2 LED 광중합기의파장이 Figure 1 에나타나있다. LED 광중합기의 peak wavelength 는 nm 로측정되었으며, 1 겹, 2 겹, 4 겹, 8 겹을투과한중합광도같은결과를보여차단막이 LED 광중합기의광강도를감소시키기는하지만파장에는영향을미치지않음을알수있다. 감염조절용차단막을투과한 Optilux 360 할로겐광중합기의파장이 Figure 2 에나타나있다. 파장의형태는차단막의두께와상관없이대체적으로비슷한모양을하고있 으며할로겐광중합기의 peak wavelength 는 nm 로측정되었고, 1 겹의차단막을투과한경우는 nm, 2 겹은 491 nm, 4 겹은 nm, 8 겹은 491 nm 로측정되어차단막의두께가할로겐광중합기의파장에미치는영향이거의없음을보여주었다. 감염조절용차단막을투과한광중합기의 light diffusion 은 Table 2 와같다. Elipar FreeLight 2 는 75 도의각도를보였으며, 차단막 1 겹을투과했을때도 75 도, 2 겹은 74 도, 4 겹은 75 도, 8 겹은 72 도의각도를보였으나차단막의두께에따른통계적유의차이는없었다 (p > 0.05). Optilux 360 의경우는 48 도로측정되었으며, 차단막 1 겹을투과했 370 Chang HS et al. JKACD Volume 35, Number 5, 2010

을때 47 도, 2 겹도 47 도, 4 겹은 45 도, 8 겹은 37 도로측정되어 Elipar FreeLight 2 에비해유의하게감소하였으며특히 8 겹의차단막을투과했을때통계적으로유의하게감소하였다 (p < 0.05).

4 Figure 3. Light diffusion from LED light curing unit with infection control barriers covering the fiberoptic bundle. Figure 4. Light diffusion from halogen light curing unit with infection control barriers covering the fiberoptic bundle. 을때 47 도, 2 겹도 47 도, 4 겹은 45 도, 8 겹은 37 도로측정되어 Elipar FreeLight 2 에비해유의하게감소하였으며특히 8 겹의차단막을투과했을때통계적으로유의하게감소하였다 (p < 0.05). 감염조절용차단막을투과한 Elipar FreeLight 2 와 Optilux 360 의중합광을 DSLR 로찍은대표사진은 Figures 3 과 4 에나타나있다. 총괄및고안 감염조절용차단막을투과한광중합기의광강도는 Optilux 360 에서차단막 1 겹과 2 겹을제외하고는두광중합기에서모두유의하게감소하였고, 차단막의두께가증가할수록광강도를많이감소시키는것으로나타났다 (p < 0.05). 또한, LED 광중합기에비해광강도가상대적으로약한할로겐광중합기에서 4 겹과 8 겹의차단막을투과한경우에광강도가더큰비율로감소하는것을보여주었다. 하지만 ISO 에서요구하는최소광강도인 300 mw/cm 2 이하로는감소하지않아복합레진의광중합에는문제가없는것으로사료되며, 8-10 여러논문에서휴대용광강도측정기로측정된광중합기의광강도로복합레진중합률의예측이가능하다고뒷받침하고있다 겹의차단막을투과한광강도는 LED 광중합기에서는 3%, 할로겐광중합기에서는 4% 의중합광이감소되는데이는이전연구에서의결과와비슷하다. Chong 등은셀로판랩을투과한할로겐광중합기의광강도를측정한결과대조군에비해약 3% 의광강도 가감소한다고하였으며, 5 Scott 등의실험에서도감염조절용차단막의종류에따라 2-6% 의광강도가감소한다고보고하였다. 7 LED 광중합기의파장은차단막이두꺼워지더라도광강도의차이만있을뿐파장의형태변화는없었으며, peak wavelength 도 nm 로차이를보이지않았다. 14 할로겐광중합기의파장역시중합광의강도는감소하였으나비교적넓은영역의파장대와 nm 의 peak wavelength 로대조군과유사한것을볼수있었다. 이결과는할로겐광중합기로실험한 Scott 등의연구와유사한결과를보였다. 7 광중합기의광조사말단에서조사되는중합광을촬영한사진에서는중합광이광조사말단에서멀어질수록방사되는형태를볼수있으며할로겐광중합기는약 48 도, LED 광중합기는약 75 도의각도로중합광이방사되었다. Price 등은할로겐광중합기인 Optilux 500 에서광조사말단의종류에따라 25 도에서 54 도의각도로중합광이방사되었다고보고하였으며, 15 이는본연구에서의할로겐광중합기의 light diffusion 과유사하다고할수있다. 차단막을투과한경우광강도가낮은할로겐광중합기에서 4 겹의차단막을투과한경우에서부터중합광의 light diffusion 이감소하기시작하여 8 겹의차단막을투과할때는 light diffusion 이대조군에비해통계적으로유의하게 10 도이상감소하여 (p < 0.05) 광강도에서의결과와마찬가지로광강도가상대적으로낮은할로겐광중합기가 LED 광중합기에비해차단막 JKACD Volume 35, Number 5, 2010 Effect of barriers on light curing units 371

5 의영향을더많이받은것으로사료된다. Elipar FreeLight 2에서는차단막의두께가 light diffusion에통계적으로유의있는영향을미지치않았다. Corciolani 등은중합광의 light diffusion이광조사말단의 entry diameter 와 exit diameter의차이 (R) 때문이라고하였으며 (R) 값이레진의중합깊이에영향을미친다고하였다. 광조사말단과복합레진과의거리가 5 mm 이하일경우 (R) 값이큰광조사말단의레진의중합깊이가증가하지만광조사말단과복합레진의거리가 5 mm를초과하는경우에는반대로레진의중합깊이가감소하였다. 16 하지만본연구에서는조사각도의차이가광조사말단의 (R) 차이가아닌차단막의두께, 즉외적인원인이기때문에중합광이차단막에의해감쇠되고, 따라서레진의중합깊이도감소시킬것으로사료된다. 추후여러겹의차단막에의한복합레진의광중합에대한연구도필요할것으로사료된다. 결 본연구는여러겹의감염조절용차단막을투과한광중합기의광강도와파장및 light diffusion 을측정하여본실험의한계내에서다음과같은결론을내릴수있다. 1. 감염조절용차단막의두께가증가할수록광중합기의광강도가유의하게감소하였으나 (p < 0.05), 할로겐광중합기의경우차단막 1 겹과 2 겹사이에는통계적유의차가없었다 (p > 0.05). 2. 감염조절용차단막은두께에상관없이중합광의파장에는영향을미치지않았다. 3. 감염조절용차단막은할로겐광중합기에서 4 겹의경우 light diffusion 의각도를감소시키고 8 겹의경우통계적으로유의하게감소시켰으나 (p < 0.05), LED 광중합기에서는차단막의두께가 light diffusion 에영향을미치지않았다. 따라서광중합형복합레진을광중합할경우감염조절용차단막이찢어지는경우가종종발생하기때문에 1 겹으로사용하기보다는 2 겹으로사용하는것이환자간의교차감염을예방하는데유리할것으로사료된다. 론 References 1. Caughman GB, Caughman WF, Napier N, Schuster GS. Disinfection of visible-light-curing devices. Oper Dent 1989;14(1): Kakaboura A, Tzoutzas J, Pitsinigos D, Vougiouklakis G. The effect of sterilization methods on the light transmission characteristics and structure of light-curing tips. J Oral Rehabil 2004;31: Rueggeberg FA, Caughman WF, Comer RW. The effect of autoclaving on energy transmission through lightcuring tips. J Am Dent Assoc 1996;127: Nelson SK, Caughman WF, Rueggeberg FA, Lockwood PE. Effect of glutaraldehyde cold sterilants on light transmission of curing tips. Quintessence Int 1997;28: Chong SL, Lam YK, Lee FKF, Ramalingam L, Yeo ACP, Lim CC. Effect of various infection-control methods for light-cure units on the cure of composite resins. Oper Dent 1998;23: Pollington S, Kahakachchi N, van Noort R. The Influence of Plastic Light Cure Sheaths on the Hardness of Resin Composite. Oper Dent 2009;34: Scott BA, Felix CA, Price RB. Effect of disposable infection control barriers on light output from dental curing lights. J Can Dent Assoc 2004;70: Fan PL, Schumacher RM, Azzolin K, Geary R, Eichmiller FC. Curing-light intensity and depth of cure of resin-based composites tested according to international standards. J Am Dent Assoc 2002;133: Park SM, Shin DH. Microhardness and microleakage of composite resin according to the change of curing light intensity. J Kor Acad Cons Dent 2001;26: Park JG, Cho BH, Lee IB, Kwon HC, Um CM. The effects of various light intensity on the polymerization of resin composites. J Kor Acad Cons Dent 2001;26: Shortall AC, Harrington E, Wilson HJ. Light curing unit effectiveness assessed by dental radiometers. J Dent 1995;23: Rueggeberg FA. Precision of hand-held dental radiometers. Quintessence Int 1993;24: Peutzfeldt A. Correlation between recordings obtained with a light-intensity tester and degree of conversion of a light-curing resin. Scand J Dent Res 1994;102: Kim SY, Lee IB, Cho BH, Son HH, Kim MJ, Seok CI, et al. Dentin bond strength of bonding agents cured with Light Emitting Diode. J Kor Acad Cons Dent 2004;29: Price RB, Derand T, Sedarous M, Andreou P, Loney RW. Effect of distance on the power density from two light guides. J Esthet Dent 2000;12: Corciolani G, Vichi A, Davidson CL, Ferrari M. The influence of tip geometry and distance on light-curing efficacy. Oper Dent 2008;33: Chang HS et al. JKACD Volume 35, Number 5, 2010

6 국문초록 감염조절용차단막의두께가광중합기의중합광에미치는영향 장훈상 * 이석련 홍성옥 류현욱 송창규 민경산원광대학교치과대학치과보존학교실및치의학연구소 연구목적 : 본연구는감염조절용차단막을여러겹으로사용했을때광중합기의광강도와파장, light diffusion 등에미치는영향에대해조사하였다. 연구재료및방법 : 감염조절용차단막은투명랩 ( 크린랩 ) 을사용하였고광중합기는할로겐광중합기 (Optilux 360) 와 LED 광중합기 (Elipar FreeLight 2) 를사용하였다. 차단막을 1 겹, 2 겹, 4 겹, 8 겹으로광중합기의광섬유말단을감싸고휴대용광강도측정기 (Cure Rite) 로광중합기의광강도를측정하였다. 광중합기를주문제작한 optical breadboard 에고정시킨후휴대용 spectroradiometer (CS-1000) 를이용하여광중합기의파장을측정하였고, DSLR (Nikon D70s) 을이용하여광중합기의 light diffusion 을사진촬영하였다. 결과 : 광강도측정결과는차단막의두께가증가할수록광강도가유의하게감소하였으나할로겐광중합기에서 1 겹과 2 겹사이에는유의차가없었으며, 4 겹이상의차단막을투과할때광강도가더많이감소하였다. 여러겹의차단막을투과한광중합기의전체적인파장형태와 peak wavelength 의변화는관찰되지않았다. Light diffusion 사진촬영시, LED 광중합기에서는차단막의두께가미치는영향이없었으나할로겐광중합기에서는차단막을 4 겹사용했을때부터중합광이조사되는각도가감소하기시작하여 8 겹사용했을때통계적으로유의하게감소하는것을볼수있었다 (p < 0.05). 결론 : 광중합형복합레진을광중합할경우감염조절용차단막이찢어지는경우를대비하여 1 겹으로사용하기보다는 2 겹으로사용하는것이환자간의교차감염을예방하는데유리할것으로사료된다. 주요단어 : 감염조절용차단막측정기 ; 광강도 ; 광중합기 ; 교차감염 ; 파장 ; 휴대용광강도 JKACD Volume 35, Number 5, 2010 Effect of barriers on light curing units 373

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<283732372D3733312920B4D9C3CAC1A120BCD2C7C1C6AEC4DCC5C3C6AEB7BBC1EEC0C720B3EBBEC8C0C720BDC3B7C2BAB8C1A4BFA120B4EBC7D120C0AFBFEBBCBA20C6F2B0A1283035292E687770> 대한안과학회지 제 49 권 제 5 호 2008 J Korean Ophthalmol Soc 49(5):727-731, 2008 DOI : 10.3341/jkos.2008.49.5.727 다초점 소프트콘택트렌즈의 노안의 시력보정에 대한 유용성 평가 김현경 1 김효명 2 정성근 1 가톨릭대학교 의과대학 성모병원 안과학교실 1, 고려대학교 의과대학 안암병원 안과학교실